Device

ABSTRACT

A seal comprises a first sealing member and a second sealing member. The sealing members each have an accessway to facilitate access from one side of the sealing member to the other side of the sealing member. The accessways are offset to facilitate sealed access of an object through the sealing members.

This application is a Continuation of U.S. application Ser. No.10/635,910, filed Aug. 7, 2003, which claims the benefit of U.S.Provisional Application No. 60/401,760, filed Aug. 8, 2002, the contentsof all of which are incorporated herein by reference in theirentireties.

INTRODUCTION

This invention relates to a surgical device. In particular it relates toa surgical device for retracting a wound opening and sealing theretracted wound opening.

STATEMENTS OF INVENTION

According to the invention there is provided a seal comprising a firstsealing member and a second sealing member, each sealing member havingan accessway to facilitate access from one side of the sealing member tothe other side of the sealing member, the accessways being offset tofacilitate sealed access of an object through the sealing members.

In one case the accessway comprises an opening in the sealing member.Preferably the opening is located substantially centrally in the sealingmember.

In another case the accessway comprises a passageway extending by thesealing member. Preferably the passageway is located substantially at anedge of the sealing member.

In one embodiment at least one sealing member is manipulable tofacilitate alignment of the accessways. Preferably the sealing member isat least partially of a flexible material. The sealing member may be atleast partially of a resilient material. Ideally the sealing member isof silicone or latex.

In a preferred case the first sealing member is coupled to the secondsealing member. Ideally the seal comprises a ring to which both thefirst sealing member and the second sealing member are coupled.

The seal may comprise means to bias the first sealing member and thesecond sealing member towards one another. Preferably the biasing meanscomprises a magnet coupled to each sealing member.

The seal may comprise three or more sealing members.

Desirably the sealing member comprises a sheet.

In another aspect the invention provides a seal comprising a firstsealing member and a second sealing member, each sealing member havingan accessway to facilitate access from one side of the sealing member tothe other side of the sealing member, and a closure member movablebetween a sealing position in which the closure member occludes at leastone accessway and an access position in which the accessways are atleast partially open for passage of an object therethrough.

In one embodiment the seal comprises means to bias the closure membertowards the sealing position. Preferably the biasing means comprises oneor more resilient members. Ideally the resilient member comprises anelastic band.

The closure member may be located between the first sealing member andthe second sealing member. Ideally the seal comprises at least onetether to prevent passage of the closure member through the accessway.

In a preferred embodiment the first sealing member is coupled to thesecond sealing member. Ideally the seal comprises a ring to which boththe first sealing member and the second sealing member are coupled.

The accessway in the first sealing member and the accessway in thesecond sealing member are preferably aligned. The accessway may comprisean opening in the sealing member. Ideally the opening is locatedsubstantially centrally in the sealing member.

In one case the sealing member comprises a collar around the opening.Preferably the collar is provided on a side of the sealing memberopposite to the closure member.

Desirably the closure member comprises a ball. The ball may bespherical.

The sealing member preferably comprises a sheet.

The invention also provides a further aspect a seal comprising a firstsealing member and a second sealing member, the sealing members beingconfigured to overlap one another such that a portion of the firstsealing member overlaps a portion of the second sealing member along afirst overlap region and a portion of the second sealing member overlapsa portion of the first sealing member along a second overlap region.

In one embodiment at least one sealing member is manipulable tofacilitate sealed passage of an object between the sealing members.Preferably the sealing member is manipulable to facilitate sealedpassage at the junction of the first overlap region and the secondoverlap region. Ideally the sealing member is at least partially of aflexible material. Most Preferably the sealing member is at leastpartially of a resilient material. The sealing member may be of siliconeor latex.

In another embodiment the area of the first overlap region issubstantially equal to the area of the second overlap region.

The first sealing member is preferably coupled to the second sealingmember. Ideally the seal comprises a ring to which both the firstsealing member and the second sealing member are coupled.

The sealing member may comprise a sheet.

In another aspect of the invention there is provided a seal comprising asleeve through which an object may be passed, and means to bias thesleeve into a closed configuration. The biasing means may be providedintegral with the sleeve.

Ideally the sleeve is configured to curl-up upon itself to the closedconfiguration.

The sleeve may alternatively be configured to twist-up upon itself tothe closed configuration.

In one case the seal comprises a platform to which the sleeve iscoupled. The platform is preferably of an annular shape. Ideally theplatform comprises a stiffening ring.

The invention also provides a surgical device comprising a seal of theinvention

In another aspect the invention provides a surgical device comprising aproximal seal and a distal seal, the distal seal comprising a seal ofthe invention.

The proximal seal may comprise a lip seal, or an iris valve.

According to another aspect the invention provides a surgical assemblycomprising a surgical device of the invention and a wound retractor.

In one embodiment the device is releasably mountable to the retractor.

In another embodiment the device is integral with the retractor.

The invention also provides in another aspect a surgical devicecomprising:

-   -   a retracting member movable from an insertion configuration to a        retracting configuration to retract laterally a wound opening;        and    -   a sealing member for sealing a retracted wound opening;    -   the sealing member having at least two accessways to facilitate        sealed access through a retracted wound opening.

In one embodiment of the invention the sealing member comprises at leastone chamber for receiving pressurised fluid to seal at least oneaccessway.

Preferably the sealing member comprises at least one iris valve to sealat least one accessway.

The sealing member may comprise at least one lip seal to seal at leastone accessway.

The sealing member is preferably rotatable in a sealed manner relativeto the retracting member.

In another aspect the invention provides a surgical device comprising:

-   -   a retracting member movable from an insertion configuration to a        retracting configuration to retract laterally a wound opening;        and    -   a sealing member for sealing a retracted wound opening;    -   the sealing member being rotatable in a sealed manner relative        to the retracting member.

In one case the sealing member is releasably mounted to the retractingmember.

The device may comprise a proximal member for location externally of awound opening, the proximal member being movable relative to theretracting member to move the retracting member to the retractingconfiguration. Preferably the proximal member comprises an annular ringmeans. Ideally the annular ring means comprises an inner ring and anouter ring between which the retracting member may be led.

The sealing member may be at least partially transparent.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention will be more clearly understood from the followingdescription of some embodiments thereof, given by way of example only,with reference to the accompanying drawings, in which:

FIG. 1 is a partially cross-sectional, front view of a surgical deviceaccording to the invention, in use;

FIG. 2 is an exploded, perspective view of a seal of the device of FIG.1;

FIG. 3 is a plan view of the seal of FIG. 2;

FIGS. 4 and 5 are partially cross-sectional, front views of the seal ofFIG. 2, in use;

FIGS. 6 and 7 are views similar to FIGS. 2 and 3 of another sealaccording to the invention;

FIG. 8 is a cross-sectional, front view of the seal of FIGS. 6 and 7;

FIGS. 9 to 11 are views similar to FIGS. 6 to 8 of another sealaccording to the invention;

FIG. 12 is a partially cross-sectional, front view of the seal of FIGS.9 to 11, in use;

FIGS. 13 and 14 are views similar to FIGS. 9 and 11 of another sealaccording to the invention;

FIGS. 15 to 17 are views similar to FIGS. 6 to 8 of another sealaccording to the invention;

FIGS. 18 to 20 are partially cross-sectional, front views of the seal ofFIGS. 15 to 17, in use;

FIGS. 21 and 22 are exploded, perspective views of other seals accordingto the invention;

FIG. 23 is a cross-sectional, front view of a further seal according tothe invention;

FIG. 24 is an exploded, perspective view of the seal of FIG. 23;

FIG. 25 is a perspective view of another seal according to theinvention;

FIG. 26 is a perspective view of the seal of FIG. 25, in use;

FIGS. 27 and 28 are views similar to FIGS. 25 and 26 of another sealaccording to the invention;

FIG. 29 is a perspective view of another seal of the device of FIG. 1;

FIGS. 30 and 31 are perspective views of the seal of FIG. 29, in use;

FIG. 32 is an exploded, perspective view of another surgical deviceaccording to the invention;

FIG. 33 is a plan view of the device of FIG. 32;

FIG. 34 is a perspective view of the device of FIG. 32, in use;

FIG. 35 is a partially cross-sectional, front view of the device of FIG.32, in use;

FIGS. 36 and 37 are plan views of the device of FIG. 32, in use;

FIGS. 38 to 40 are plan views of other surgical devices according to theinvention;

FIG. 41 is a plan view of a further surgical device according to theinvention, in use;

FIGS. 42 and 43 are perspective views of other surgical devicesaccording to the invention; and

FIG. 44 is a perspective view of the device of FIG. 43, in use.

DETAILED DESCRIPTION

Referring to FIG. 1 there is illustrated a surgical device 1 accordingto the invention. The device 1 has a proximal seal 2 which is normallyopen, and a distal seal 3 which is normally closed. This dual sealarrangement facilitates passage of an object, such as a surgeon'sforearm 4, through the device 1 into a body cavity in a sealed manner.The surgical device 1 may thus be used to maintain pneumoperitoneumduring hand-assisted laparoscopic surgery.

In this case, the proximal seal 2 is provided in the form of a lip seal.

FIGS. 2 to 5 illustrate the distal seal 3 in further detail. The distalseal 3 comprises three sealing members 5, 6, 7. In this case, eachsealing member 5, 6, 7 is provided in the form of a sheet coupled to acircumferentially extending O-ring 8.

Each sealing member 5, 6, 7 has an accessway 9, 10, 11 respectively tofacilitate access from one side of the sealing member to the other sideof the sealing member. The accessways 9, 11 are provided in the form ofcircular openings through the sealing members 5, 7 located centrally inthe sealing members 5, 7. The accessway 10 is provided in the form of acrescent-shaped passageway at the edge of the sealing member 6.

As illustrated in FIG. 2, the opening 9 is offset from the passageway10, and the passageway 10 is offset from the opening 11. In this mannerthe sealing members 5, 6, 7 are normally closed to prevent leakage ofinsufflation gas through the distal seal 3.

The sealing members 5, 6, 7 are manipulable to facilitate alignment ofthe accessways 9, 10, 11, as illustrated in FIG. 4. When the accessways9, 10, 11 have been aligned, the surgeon's hand and arm 4 may be passedthrough the distal seal 3 to gain access to an internal body cavityand/or internal body organs, as illustrated in FIG. 5.

A suitable material for the sealing members 5, 6, 7 to enablemanipulation of the sealing members 5, 6, 7 is a flexible material, suchas silicone or latex. The sealing members 5, 6, 7 are preferably also ofa resilient material to ensure that the sealing members 5, 6, 7 returnto the normally closed position after withdrawal of the surgeon's arm 4.

In FIGS. 6 to 8 there is illustrated another distal seal 20 according tothe invention, which is similar to the distal seal 3 of FIGS. 1 to 5,and similar elements in FIGS. 6 to 8 are assigned the same referencenumerals.

In this case the distal seal 20 comprises an arcuate magnet 21 coupledto a proximal surface of the proximal sealing member 5, and an arcuatemagnet 22 coupled to a distal surface of the distal sealing member 7.The magnets 21, 22 act to bias the sealing members 5, 7 towards oneanother with the middle sealing member 6 sandwiched in between. Thismagnetic arrangement enhances the gas-tight seal achieved by the distalseal 20.

Referring to FIGS. 9 to 12 there is illustrated another distal seal 30according to the invention, which is similar to the distal seal 3 ofFIGS. 1 to 5, and similar elements in FIGS. 9 to 12 are assigned thesame reference numerals.

In this case, each accessway 31, 32, 33 is provided in the form of apassageway at the edge of the sealing member 5, 6, 7 respectively. Themiddle passageway 32 is offset from the proximal and distal passageways31, 33 respectively. In this manner the sealing members 5, 6, 7 arenormally closed to prevent leakage of insufflation gas through thedistal seal 30.

Use of the distal seal 30 proceeds in a manner similar to that describedpreviously with reference to the distal seal 3 of FIGS. 1 to 5.

FIGS. 13 and 14 illustrate a further distal seal 40 according to theinvention, which is similar to the distal seal 30 of FIGS. 9 to 12, andsimilar elements in FIGS. 13 and 14 are assigned the same referencenumerals.

The distal seal 40 comprises a magnet 41 coupled to the proximal surfaceof the proximal sealing member 5, and a magnet 42 coupled to the distalsurface of the distal sealing member 7, in a manner similar to thatdescribed previously with reference to the distal seal 20 of FIGS. 6 to8.

Referring to FIGS. 15 to 20 there is illustrated another distal seal 50according to the invention which is suitable for use with the surgicaldevice 1.

The distal seal 50 comprises two sealing members 51, 52 and a sphericalball 56. In this case each sealing member 51, 52 is provided in the formof a sheet coupled to a circumferentially extending O-ring 53.

Each sealing member 51, 52 has an accessway 54, 55 respectively tofacilitate access from one side of the sealing member to the other sideof the sealing member. The accessways 54, 55 are provided in the form ofcircular openings through the sealing members 51, 52 located centrallyin the sealing members 51, 52. As illustrated in FIGS. 15 and 16, theaccessways 54, 55 are aligned.

The ball 56 is located between the two sealing members 51, 52, asillustrated in FIG. 17. As illustrated in FIG. 18, the ball 56 ismovable laterally within the two sealing members 51, 52 from a sealingposition in which the ball 56 occludes the two accessways 54, 55 (FIG.17), to an access position in which the accessways 54, 55 are open forpassage of the surgeon's arm 4 therethrough (FIGS. 19 and 20).

When the ball 56 is in the sealing position (FIG. 17), the distal seal50 prevents escape of insufflation gas from a body cavity. When the ball56 is in the access position (FIGS. 19 and 20), the distal seal 50facilitates sealed access of the surgeon's arm 4 through the distal seal50 to the body cavity.

The ball 56 may be tethered to the O-ring 53 by means of a tether line61, as illustrated in the distal seal 60 of FIG. 21. The tether line 61thus prevents inadvertent passage of the ball 61 out from between thesealing members 51, 52 through one of the accessways 54, 55.

In the distal seal 70 of FIG. 22, the ball 56 is connected to the O-ring53 by three resilient members 71, 72, 73, for example elastic bands. Theresilient members 71, 72, 73 act to bias the ball 56 towards the centralsealing position occluding the two accessways 54, 55. In this manner,upon removal of the surgeon's aim 4 from the distal seal 70, the ball 56is moved back to the sealing position to prevent loss of insufflationgas from the body cavity.

A collar 81 may be provided around the accessway 81 on the proximalsurface of the proximal sealing member 51, as illustrated in FIGS. 23and 24. It has been found that such a collar arrangement enhances thesealing of the ball 56 to the sealing member 51 around the opening 54.

In FIGS. 25 and 26 there is illustrated another distal seal 96 accordingto the invention, which is suitable for use with the surgical device 1.

The distal seal 96 comprises two sealing members 90, 91. In this caseeach sealing member 90, 91 is provided in the form of a sheet coupled toa circumferentially extending O-ring 92.

The sealing members 90, 91 overlap one another such that a portion ofthe sealing member 90 overlaps a portion of the sealing member 91 alonga first overlap region 94, and a portion of the sealing member 91overlaps a portion of the sealing member 90 along a second overlapregion 93, as illustrated in FIG. 26. In this manner the distal seal 96is normally closed to prevent escape of insufflation gas between thesealing members 90, 91 (FIG. 25).

The sealing members 90, 91 are manipulable to facilitate sealed passageof an object, such as the surgeon's arm 4, through the distal seal 96 atthe junction 95 of the two overlap regions 93, 94 to gain access to aninternal body cavity and/or internal body organs, as illustrated in FIG.26.

A suitable material for the sealing members 90, 91 to enablemanipulation of the sealing members 90, 91 is a flexible material, suchas silicone or latex. The sealing members 90, 91 are preferably also ofa resilient material to ensure that the sealing members 90, 91 return tothe normally closed position after withdrawal of the surgeon's arm 4.

In this case the area of the two overlap regions 93, 94 is substantiallyequal.

Referring next to FIGS. 27 and 28, there is illustrated another distalseal 100 according to the invention, which is suitable for use with thesurgical device 1.

The seal 100 comprises a sleeve 101 through which an object, such as asurgeon's arm 4, may be passed and an annular platform 102. The platform102 has an O-ring 103 to stiffen the platform 102.

The sleeve 101 is configured to curl-up upon itself as illustrated inFIG. 27, and thereby bias itself into a normally closed configuration.In this closed configuration the curled sleeve 101 prevents the escapeof insufflation gas from a body cavity through the distal seal 100.

To gain access to an internal body cavity or internal body organs, thesurgeon inserts his arm 4 through the sleeve 101 which causes the sleeve101 to uncurl (FIG. 28).

It will be appreciated that other self-closing configurations arepossible for the sleeve 101. For example, the sleeve 101 mayalternatively be configured to twist-up upon itself to the closedconfiguration.

It will be understood that a wide variety of possible configurations forthe proximal seal of the surgical device 1 are possible within the scopeof this invention. For example, the proximal seal may comprise an irisvalve 110, as illustrated in FIGS. 29 and 30.

The proximal seal may additionally or alternatively be in the form ofone of the seals described previously with reference to FIGS. 2 to 28.

Furthermore it will be appreciated that the surgical device 1 and theseals according to the invention are suitable for sealing a variety ofobjects, such as a surgical instrument 120, as illustrated in FIG. 31.

The surgical device 1 of the invention could be used in configurationwith a wound retractor. In one case the device 1 could be releasablymounted to the retractor. In another case the device 1 could be providedintegral with the retractor.

Referring now to FIGS. 32 to 37 there is illustrated another surgicaldevice 130 according to the invention.

The device 130 comprises a wound retractor 131 and a domed sealingmember 132.

The wound retractor 131 is similar to the surgical wound retractordescribed in international patent application number PCT/IE00/00126, therelevant contents of which are incorporated herein by reference. Inparticular, the retractor 131 comprises a distal O-ring 139 forinsertion into a wound opening 138, a retracting sleeve 135, and aproximal annular ring means.

The proximal annular ring means comprises an outer ring 141 and an innerO-ring 140 which is partially located in a recess of the outer ring 141.The sleeve 135 passes through the proximal annular ring means betweenthe inner and outer rings 140, 141 (FIG. 35).

To retract the wound opening 138, the distal O-ring 139 is inserted intothe wound opening 138 to another the wound retractor 131 in position inthe wound opening 138. The proximal rings 140, 141 are then moveddownwardly while pulling the sleeve 135 upwardly to move the sleeve 135lining the wound laterally to a retracting configuration, and therebyretract the sides of the wound opening 138 laterally.

The sealing member 132 comprises two accessways 136, 137 through thesealing member 132, through which the left and right arms 133, 134 of asurgeon may be extended to gain access to an internal body cavity orinternal body organs.

By providing two access openings 136, 137 in the sealing member 132,this enables the surgeon to extend both arms 133, 134 through theretracted wound opening 138 in a sealed manner. Thus it is possible forthe surgeon to perform procedures with both hands, such as suturing,while maintaining the pneumoperitoneum.

The sealing member 132 is releasably mounted to the wound retractor 131in a retractable manner. Thus as illustrated in FIGS. 36 and 37, it isrelatively simple to rotate the sealing member 132 and thus theaccessways 136, 137 to enable the surgeon access a desired region ororgan within the sealed internal body cavity.

It will be appreciated that means may be provided to seal the accessways136, 137 when not in use, and to seal around an object, such as thesurgeon's arms 133, 134, extending through the accessways 136, 137.

In the surgical device 150 of FIG. 38, lip seals 151 are provided ateach accessway 136, 137 to effect the sealing function.

In the surgical device 160 of FIG. 39, each accessway 136, 137 has aninflatable chamber 161. By passing a pressurised fluid into the chamber161 the accessways 136, 137 may be sealed. In this case the chamber 161is defined by a sleeve turned back on itself to define an outer sleevesection and an inner sleeve section with the chamber definedtherebetween. The inner sleeve section is twisted and the outer sleevesection is substantially cylindrical. Upon passage of an object, such asthe surgeon's arms 133, 134 through the inflated sleeve, the sleeveeverts. In this regard the chamber 161 is similar to the medical devicedescribed in International patent application number PCT/IE99/00123, therelevant contents of which are incorporated herein by reference.

In the surgical device 170 of FIG. 40, iris valves 171 are provided ateach accessway 136, 137 to effect the sealing function.

As illustrated in the surgical device 180 of FIG. 41, the sealing member181 may be at least partially transparent for enhanced visualisation ofthe sealed internal body cavity and/or internal body organs.

It will be appreciated that the surgical devices according to theinvention may also be configured to seal objects other than a human armextended through an accessway of the sealing member 132, for example asurgical instrument.

Furthermore an accessway 192 may be provided through the sealing member132 for a surgical instrument 191 in addition to the two arm accessways136, 137, as illustrated in the surgical device 190 of FIG. 42.

As a further alternative a bag 201 may be attached to the sealing member132 at a bag opening 202, as illustrated in the surgical device 200 ofFIGS. 43 and 44. The bag 201 is gas-tightly sealed to the sealing member132 at the opening 202 to maintain the pneumoperitoneum. An internalorgan of the patient, such as portion of the colon 203, may betemporarily moved into the bag 201 for closer examination and/or tocreate extra space within the body cavity.

The invention is not limited to the embodiments hereinbefore described,with reference to the accompanying drawings, which may be varied inconstruction and detail.

The invention claimed is:
 1. A medical device, comprising: a woundprotector, including: a proximal ring assembly having a proximal ringmember including a central longitudinal axis, a distal ring, awound-engaging sleeve extending between the proximal ring member and thedistal ring, and the proximal ring assembly further including a sealingmember having a plurality of access portions that provide access throughthe sealing member, wherein a first access portion of the plurality ofaccess portions is closer to the central longitudinal axis of theproximal ring member than a second access portion of the plurality ofaccess portions, and wherein the sealing member is rotatable relative tothe proximal ring member to facilitate rotation of the plurality ofaccess portions relative to the proximal ring member about the centrallongitudinal axis of the proximal ring member.
 2. The medical device ofclaim 1, wherein the plurality of access portions include a plurality ofpassages through the sealing member.
 3. The medical device of claim 2,wherein the sealing member further includes one or more instrument sealsfor providing sealed access through the plurality of passages.
 4. Themedical device of claim 3, wherein an instrument seal of the one or moreinstrument seals includes a valve movable between an open configurationand a closed configuration.
 5. The medical device of claim 1, wherein atleast two of the access portions are offset from the centrallongitudinal axis of the proximal ring member.
 6. The medical device ofclaim 1, wherein the first access portion and the second access portionhave different widths.
 7. A medical device, comprising: a woundprotector, including: a proximal ring assembly having a proximal ringmember including a central longitudinal axis, a distal ring, awound-engaging sleeve extending between the proximal ring member and thedistal ring, and the proximal ring assembly further including a sealingmember having access portions that provide access through the sealingmember, wherein the access portions include a first access portion and asecond access portion, the first access portion and the second accessportion have different widths, and the sealing member is rotatablerelative to the proximal ring member to facilitate rotation of the firstaccess portion and the second access portion relative to the proximalring member.
 8. The medical device of claim 7, wherein an axis ofrotation of the sealing member is coaxial with a central longitudinalaxis of the proximal ring member.
 9. The medical device of claim 7,wherein one of the first and second access portions is closer to acenter of the sealing member than the other of the first and secondaccess portions.
 10. The medical device of claim 7, wherein the sealingmember further includes an instrument seal for providing sealed accessthrough one of the first and second access portions.
 11. The medicaldevice of claim 7, wherein a central longitudinal axis of the firstaccess portion is offset from a central longitudinal axis of theproximal ring member.
 12. The medical device of claim 11, wherein acentral longitudinal axis of the second access portion is offset fromthe central longitudinal axis of the proximal ring member.
 13. Themedical device of claim 7, wherein each of the first access portion andthe second access portion includes an opening in the sealing member. 14.A medical device, comprising: a wound protector, including: a proximalring assembly having a proximal ring member, a distal ring, awound-engaging sleeve extending between the proximal ring member and thedistal ring, and the proximal ring assembly further including a sealingmember having one or more instrument seals and a plurality of accessportions that provide sealed access through the sealing member, whereina first access portion of the plurality of access portions is morecentral on the sealing member than a second access portion of theplurality of access portions, and wherein the sealing member isrotatable relative to the proximal ring member to facilitate rotation ofthe one or more instrument seals and the plurality of access portionsrelative to the proximal ring member.
 15. The medical device of claim14, wherein an axis of rotation of the sealing member is coaxial with acentral longitudinal axis of the proximal ring member.
 16. The medicaldevice of claim 14, wherein the sealing member includes a plurality ofsaid instrument seals.
 17. The medical device of claim 16, whereincentral longitudinal axes of two instrument seals of the plurality ofsaid instrument seals are offset from a central longitudinal axis of theproximal ring member.
 18. The medical device of claim 14, wherein thesealing member is rotatably supported by the proximal ring member. 19.The medical device of claim 14, wherein the first access portion of theplurality of access portions and the second access portion of theplurality of access portions have different widths.
 20. The medicaldevice of claim 14, wherein the first access portion of the plurality ofaccess portions is more central on the sealing member than a thirdaccess portion of the plurality of access portions.